1. Field of the Invention
The present invention relates to a method and device for anesthetizing and intubating, and more particularly, the present invention relates to a method and device for anesthetizing and intubating a patient with a single hand movement.
2. Background
Laryngo-tracheal anesthesia (LTA) is an important component of the anesthetic plan for general anesthesia during surgery. LTA blunts airway reflexes and discomfort involved in the manipulation of the airway for surgery and facilitates placement and maintenance of an endotracheal tube (ETT). Of the approximately 15 million general anesthetic procedures performed each year that require an ETT, about one third will require the use of LTA.
Often laryngo-tracheal anesthetic is applied just prior to placement of the endotracheal tube. Typically, the anesthetist visualizes the vocal cords by direct laryngoscopy, places a cannula connected to a syringe containing a local anesthetic thru the vocal cords, and sprays the local anesthetic within the trachea and oropharynx. In a second direct laryngoscopy, the anesthetist places the endotracheal tube through the vocal cords and into the trachea by sliding the ETT over a wire (here, commonly referred to as a stylet) or, in some cases an introducer.
These two or more discreet steps potentially distract the anesthetist who must first reach for the LTA device and then the ETT. Also, the act of direct laryngoscopy places a great deal of stress on the patient. Placement of the laryngoscope blade on or near the epiglottis causes exaggerated sympathetic reflexes (and concomitant blood pressure swings) because of the extreme nerve sensitivity in this area. Many patients, such as those with heart disease, do not tolerate these large swings in blood pressure and in heart rate which can occur with multiple acts of direct laryngoscopy.
Additionally, prolonged direct laryngoscopy creates increased risks for the patient. The best view of the vocal cords is obtained on the first attempted direct laryngoscopy. Prolonging direct laryngoscopy causes increased edema, tissue trauma, bleeding, and secretions, which all impair the view of the vocal cords by the time the ETT is to be placed. The actual injection of the LTA liquid also obscures the view. During this time period, the trachea is unprotected and the risk of aspiration is increased. Also, on occasion the stimulation caused by LTA placement in an incompletely paralyzed patient may cause reflexive spasm of the vocal cords, thus preventing placement of the ETT altogether.
Often a “top heavy” intubation device, when loaded into an endotracheal tube inadvertently causes trauma to the eyes and face of the patient during manipulation of the device.
Attempts have been made to administer LTA through an ETT. However, these devices require extreme dexterity as the anesthesiologist must change hand positions multiple times to inject the LTA and place the ETT. For example, the anesthesiologist uses one hand position to initially access the vocal cords, another hand position to dispense anesthesia, and yet another hand position to advance the ETT. Changing hand positions is further complicated because the anesthesiologist must dedicate one hand to holding the laryngoscope blade. Therefore the intended benefit of decreased direct laryngoscopy time and a less traumatic experience to the patient is largely lost. In fact, the greatest challenge of such a combined stylet and LTA device is to be able to perform the intended function of LTA application without increasing the current level of difficulty, dexterity, and skill needed to administer the LTA, all without increase movement of the device in situ.
A need exists in the art for a method and system to allow for injection of local anesthetic while still holding an ETT in the proper position for intubation. The method and device should decrease the difficulty of intubating patients by acting as an introducer or “bougie.” Further still, the device should not add much weight and bulk to the top of the endotracheal tube.